Utahns for the Medicaid Expansion held a rally in the rotunda at the state Capitol on Wednesday, Nov. 20, 2013, in Salt Lake City. The group rallied to show Gov. Gary Herbert he has support if he decides to expand Medicaid. (Matt Gade, Deseret News)

SALT LAKE CITY — As the governor and state Legislature continue to mull over the decision to expand Medicaid in Utah, the Utah Hospital Association has come out with a position to do it — but only for a portion of the state's low-income population.

The health care policy and advocacy group believes it is important for the state of Utah to "take care of its own," but to also thoughtfully develop a unique solution to insure individuals up to 138 percent of the federal poverty level, according to the association's new president, former Lt. Gov. Greg Bell.

"As a matter of the social compact, as a social safety net, we ought to extend Medicaid coverage to those folks living under 100 percent of the federal poverty level," Bell said. "It's just very difficult to get them coverage otherwise. They just can't afford it."

Utahns for the Medicaid Expansion held a rally in the rotunda at the state Capitol on Wednesday, Nov. 20, 2013, in Salt Lake City. The group rallied to show Gov. Gary Herbert he has support if he decides to expand Medicaid. (Matt Gade, Deseret News)

Utahns earning above 138 percent of the poverty level can qualify for federal subsidies and obtain insurance through the federal health insurance marketplace.

The Utah Hospital Association has said the state should pursue creative ways to help people who live on wages between 100 percent and 138 percent of the federal poverty level — many of whom already purchase private insurance from Utah systems — obtain coverage.

Bell mentioned the possibility of the state seeking a federal waiver to get what the government would have provided Utah to pay for the expansion and offer it as premium subsidies to individuals and families needing help affording health care.

He said adopting a full expansion, however, could harm Utah's "robust private insurance market."

Other states, such as Wisconsin, Iowa and Arkansas, have sought similar ways to make their state-based programs work. Bell is encouraging Utah to do the same.

The Revs. Scott Dalgarno and Catherine Putnam-Netto with Wasatch Presbyterian Church hold signs during the Utahns for the Medicaid Expansion rally in the rotunda at the state Capitol on Wednesday, Nov. 20, 2013, in Salt Lake City. The group rallied to show Gov. Gary Herbert he has support if he decides to expand Medicaid. (Matt Gade, Deseret News)

In addition to possible solutions, the hospital association has said the state should make its decision soon.

"The sooner, the better," Bell said.

The organization, which lobbies for Utah hospital systems, stands ready to assist state leaders in their "momentous" decision, to "bring coverage and quality health care within the reach of all Utahns," according to a statement by the association.

"It is true, we all know, and studies have shown, that people with health coverage have much better health," Bell said.

Others throughout the state chimed in Wednesday as well, rallying at the Capitol rotunda to ask the governor to adopt Medicaid expansion, albeit a full and wide-sweeping model.

"I think the whole reason for us here on the Earth is to learn to be compassionate," said Nelda Bishop, one of roughly 150 who gathered in support of expansion.

Utahns for the Medicaid Expansion rallies in the rotunda at the state Capitol on Wednesday, Nov. 20, 2013, in Salt Lake City. The group rallied to show Gov. Gary Herbert he has support if he decides to expand Medicaid. (Matt Gade, Deseret News)

Attendees were asked to fill out postcards — to be sent to Gov. Gary Herbert in batches of 10 — indicating their support for the expansion.

"We're the richest nation in the world. Surely we can find a way to get basic health care to our poor," Dr. Ray Ward, a family physician and expansion supporter, told the Deseret News.

Avery Pizzuto, 13, said she is one of three daughters being raised by a self-employed single mother who has been on and off Medicaid while trying to pay for cancer treatment and follow-up care.

"I'm asking you to please help my mom and others out there like her," Avery said. "It would take a huge burden off my shoulders."

Representatives from 27 advocacy organizations from throughout the state also issued statements of support for expansion.

Dr. Barrett Bonella shows his support during the Utahns for the Medicaid Expansion rally in the rotunda at the state Capitol on Wednesday, Nov. 20, 2013, in Salt Lake City. The group rallied to show Gov. Gary Herbert he has support if he decides to expand Medicaid. (Matt Gade, Deseret News)

More than 370,000 Utahns do not have health insurance, and roughly 123,000 would qualify under federally and state-funded Medicaid programs if there was a full expansion.

Under the Affordable Care Act, the federal government has said it will fully fund expansion in states that opt in, decreasing federal funding to 90 percent after the first three years.

Rep. Rebecca Chavez-Houck, D-Salt Lake City, said taxpayer money will go toward helping those in other states if Utah does not take advantage of the expansion.

"The feds aren't going to give us a rain check if we start later," she said.

Utah is not the only state still undecided on the matter, but states that delay a decision or choose not to expand coverage will forgo available federal funds. Some lawmakers and others in the state, however, have questioned whether Utah should make a decision hinging on uncertain federal funds.

Utahns for the Medicaid Expansion held a rally in the rotunda at the state Capitol on Wednesday, Nov. 20, 2013, in Salt Lake City. The group rallied to show Gov. Gary Herbert he has support if he decides to expand Medicaid. (Matt Gade, Deseret News)

As of late October, Utah was among 21 states that had not signed on for Medicaid expansion, and one of five looking into Medicaid options, according to the Henry J. Kaiser Family Foundation.

Gov. Herbert has said he is still deciding whether to expand the state's Medicaid coverage, but he plans to declare a position on the matter before the start of the upcoming legislative session, which begins in late January.

"It's a very complex issue. It's easy for people to have a knee-jerk, do this or do that, or don't do this or don't do that, without understanding all the ramifications or complications," the governor said during his monthly news conference on KUED Ch. 7, last Thursday.

A study commissioned by the Utah Department of Health earlier this year found that expanding Medicaid to an additional 123,000 Utahns could save the state more than $11 million in fiscal year 2015.

Kate Colbath, center, gets people to fill out postcards to be sent to their local representatives and Gov. Gary Herbert during the Utahns for the Medicaid Expansion rally in the rotunda at the state Capitol on Wednesday, Nov. 20, 2013, in Salt Lake City. The group rallied to show Herbert he has support if he decides to expand Medicaid. (Matt Gade, Deseret News)

The governor said that's worth considering but added: "I don't know that it's going to tip the scales one way or the other. In a $13 billion budget, $11 million is not enough to redirect our priorities, but it's certainly a sizable amount of money."

It is estimated that nearly 60,000 currently uninsured Utahns would not be able to afford health insurance if the state does not adopt an expansion of Medicaid.

Herbert pledged his Medicaid expansion plan will take care of the most vulnerable Utahns but also protect taxpayers, both in the short and long term.